Acid Reflux Increases Susceptibility to Laryngopharyngeal and Oropharyngeal Cancers

Abstract

N owadays, people's daily routines are becoming increasingly irregular, particularly when it comes to eating and drinking. For example, people need to cope with pressures at work and rely on coffee to get them through the day. Some people even drink coffee as they would water, which could lead to heartburn in the long term. As the esophagus is unable withstand gastric acid like the stomach wall can, persistent exposure to gastric acid may corrode the esophagus. Previous studies have found that longterm corrosion of the esophagus by gastric acid could result in esophageal cancer [1]. Refluxing, though, does not stop at the esophagus (Figure 1); the gastric acid continues upwards to the pharynx, larynx, oral cavity, and nasal cavity, which can cause certain discomfort, such as a foreign body sensation in the throat, difficulties swallowing, and hoarseness after awakening. The author has had several patients who have come to the clinic complaining about an inability to cough out phlegm in their throat, no matter what they do. For some relief, they constantly clear their throat, but this relief is only temporary. An otolaryngoscopic examination would show that their laryngeal mucosa has become extremely swollen due to gastric acid burn. Other patients have complained about coughing for months. Yet, chest X-rays and visits to pulmonologists would show nothing remarkable. When the author tells patients that the cause of their discomfort may be acid reflux, 6 out of 10 patients would say, "But I don't have acid reflux!" or "Doctor, you must be wrong! I just had a gastroscopy last month and the gastroenterologist said I was fine!" Indeed, otolaryngologists and gastroenterologists may differ in the management of the acid reflux related disorders [2,3]. The fact is that the patients may have laryngopharyngeal reflux (LPR) rather than gastroesophageal reflux disease (GERD). In GERD, the reflux of gastric contents is limited to the esophagus. In LPR, the reflux of gastric content affects the larynx and pharynx. Despite occasional cross-diagnoses of GERD and LPR, there are essential differences. GERD is accompanied by acidity and heartburn (retrosternal burning), which is rarely encountered in LPR patients. In GERD, reflux and acidity typically occur during the night (nocturnal refluxers). In LPR, reflux typically occurs during the day (daytime refluxers). LPR symptoms occur when patients are in an upright position during periods of physical exertion (e.g., bending over, Valsalva, and exercise), whereas GERD reflux occurs while patients are lying down [4].

HPV and head and neck cancers: Towards early diagnosis and prevention

“…On top, certain diseases, such as gastroesophageal reflux disease (GERD) [ 39 ] or laryngopharyngeal reflux disease (LPRD) [ 40 , 41 ], can increase the risk on head and neck cancer, as well as a weakened immune system [ 16 ], and especially a previous history of head and neck cancer.…”